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Minn. reporter shares insights on covering the dental therapist debate Date: 07/27/17

Stephanie Dickrell

By Mary Otto

The debate over dental therapists continues to roil state houses across the country.

Many organized dental groups contend the technically trained providers lack the skills to perform irreversible procedures such as drilling teeth. Meanwhile, public health and grassroots supporters of a wider use of dental therapists contend that this is a good way to get cost-effective, badly needed care to poor, underserved and rural communities.

Dental therapists have been providing care in Alaskan tribal areas for more than a decade. In 2009, Minnesota became the first state to adopt the model for use statewide. Now about 70 of the new dental workers, sometimes compared to nurse practitioners, are offering preventive and restorative care in clinics and dental offices around the state.

So how are Minnesota’s dental therapists doing so far? Are they making a difference? Reporter Stephanie Dickrell of the St. Cloud Times decided to find out. In one recent story, she reported that, while dental therapists still represent only a small fraction of Minnesota’s dental workforce, they appear to be helping reduce waiting times for appointments and increasing access to care in the communities they serve.

In the following Q and A, Dickrell offers insights into her reporting on dental needs in her community and the challenges and rewards she finds on her wide-ranging beat. She also provides tips to fellow reporters on reporting dental stories in their states.

Q: You stay very busy covering local nonprofits, volunteering, health and wellness, parenting, religion and cultural and diverse communities for the St. Cloud Times. In recent times, in addition to writing about Minnesota's dental therapist initiative, you have filed stories on everything from the opening of a popular fishing tournament to a measles outbreak to a police chase involving a runaway pig. Does your broad beat affect the way you find and report on health care issues?

A: Definitely. There's never enough time for any of it. I try to find ways of double-dipping: a nonprofit that is working on a health issue, volunteering in diverse communities, etc. I also try to use spot news as an opportunity for enterprise and prevention stories.

Q: What feedback have you or your paper gotten on your dental therapist reporting?

A: We heard back from area dentists that they loved the story. I’m really not sure why this particular story caught their attention. I know people appreciate you showing solutions and not just problems. I also think people in the sector are just grateful for some attention to the disparities. It’s a very undercovered topic and one that can have a huge impact on health.

Q: Though dental therapists are working in tribal areas in Alaska, Washington and Oregon, and have been approved in Maine and Vermont, Minnesota was the first state to have adopted the model, and have dental therapists working statewide. As you have pointed out in your coverage, other states across the country are watching Minnesota to see whether dental therapists can make a difference in getting care to underserved patients. I think your recent piece on dental therapists got attention beyond St. Cloud. Can you tell us more?

A: My story included news from then-newly released studies, looking at the success of programs in Minnesota. The use of dental therapists is still relatively new here, so these studies are (just) starting to come out. So I'm sure other states are watching.

Q: As part of offering a six-year retrospective, you looked at the economics of dental therapists. What did you find out?

A: I found that while they were created to help low-income people using public insurance, private dentists are finding out how they work in their practices. Many private dentists say the economics make it hard to serve patients with public insurance. In Minnesota, reimbursement rates from the state are so low that they often limit the number of appointments. Dental therapists make that gap between cost and reimbursement smaller and allow the practice to see more patients. I don't know how or if it would work in other states. Researchers are just getting studies underway to look at how the finances work.

Q: In addition to your main story, you interviewed Kassie Scott, a dental therapist working in a local clinic. Did anything she told you about her work come as a surprise?

A: Not really. She was the only dental therapist at that office. It took the staff a few months to figure out the best way to use her. I would have liked to hear from dental therapists in offices where there is a pool (of therapists) working under a few dentists.

Q: As you pointed out in your recent report, the state's roughly 70 dental therapists represent only a small portion of the state's dental workforce so far. The unmet need for more dental care remains pretty huge. Since your story ran, the state received a warning from the federal Centers for Medicare and Medicaid saying that it could face the consequences if it does not step up its game and get care to more Medicaid children. Are you planning another story?

A: Always. The challenge at the moment is the limited number of spots (in the) training programs that exist. Studies that show dental therapists make an impact on underserved populations and can work economically will only spur more programs. It seems like dental therapists will be drawing from the pool of people wanting to become hygienists and assistants, not from people who want to become dentists. More to do.

Q: Do you have any advice for other busy reporters who work in states that may be considering licensing dental therapists? What is the best way for them to get up-to-speed on this emerging type of dental worker?

A: I first stumbled across the challenges in the dental industry via my daily media diet. This Slate story is old, but probably a good primer: And this story talks about how dental practices are organized in the United States and the economics of it.

Beyond that, I suggest breaking up the work. I would start with looking at the state of dentistry in your state. Are low-income kids getting regular, preventative care? Low-income adults? There's a story. I’d look for organizations looking to get care to those underserved populations, and what solutions they see. There's a story. Then I’d call some states or reservations where they are being used to see how it works and if it could work near you. There’s another story.